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Real Life Among the Old Old

I RECENTLY turned 65, just ahead of the millions in the baby boom generation who will begin to cross the same symbolically fraught threshold in the new year to a chorus of well-intended assurances that “age is just a number.” But my family album tells a different story. I am descended from a long line of women who lived into their 90s, and their last years suggest that my generation’s vision of an ageless old age bears about as much resemblance to real old age as our earlier idealization of painless childbirth without drugs did to real labor.

In the album is a snapshot of my mother and me, smiling in front of the Rockefeller Center Christmas tree when she was 75 and I was 50. She did seem ageless just 15 years ago. But now, as she prepares to turn 90 next week, she knows there will be no more holiday adventures in her future. Her mind is as acute as ever, but her body has failed. Chronic pain from a variety of age-related illnesses has turned the smallest errand into an excruciating effort.

On the next page is a photograph of my maternal grandmother and me, taken on a riverbank in 1998, a few months short of her 100th birthday. For one sunny afternoon, I had spirited her away from the nursing home where she spent the last three years of her life, largely confined to a wheelchair, with a bright mind — like my mother’s today — trapped in a body that would no longer do her bidding.

“It’s good to be among the living again,” Gran said, in a tone conveying not self-pity but her own realistic assessment that she had lived too long to live well.

Yet people my age and younger still pretend that old age will yield to what has long been our generational credo — that we can transform ourselves endlessly, even undo reality, if only we live right. “Age-defying” is a modifier that figures prominently in advertisements for everything from vitamins and beauty products to services for the most frail among the “old old,” as demographers classify those over 85. You haven’t experienced cognitive dissonance until you receive a brochure encouraging you to spend thousands of dollars a year for long-term care insurance as you prepare to “defy” old age.

“Deny” is the word the hucksters of longevity should be using. Nearly half of the old old — the fastest-growing segment of the over-65 population — will spend some time in a nursing home before they die, as a result of mental or physical disability.

Members of the “forever young” generation — who, unless a social catastrophe intervenes, will live even longer than their parents — prefer to think about aging as a controllable experience. Researchers who were part of a panel discussion titled “90 Is the New 50,” presented at the World Science Festival in 2008, spoke to a middle-aged, standing-room-only audience about imminent medical miracles. The one voice of caution about inflated expectations was that of Robert Butler, the pioneering gerontologist who was the first head of the National Institute on Aging in the 1970s and is generally credited with coining the term “ageism.”

Earlier this year, a few months before his death from leukemia at age 83, I asked Dr. Butler what he thought of the premise that 90 might become the new 50. “I’m a scientist,” he replied, “and a scientist always hopes for the big breakthrough. The trouble with expecting 90 to become the new 50 is it can stop rational discussion — on a societal as well as individual level — about how to make 90 a better 90. This fantasy is a lot like waiting for Prince Charming, in that it doesn’t distinguish between hope and reasonable expectation.”

The crucial nature of this distinction has become foremost in my thinking about what lies ahead.

My hope is that I will not live as long as my mother and grandmother. We all want to be the exceptions: Elliott Carter, an active composer when he walked onto the stage of Carnegie Hall for his centennial tribute in 2008; Betty White, a bravura comedian who wows audiences at 88; John Paul Stevens, the author of brilliant judicial opinions until the day he retired from the Supreme Court at 90. I, too, hope to go on being productive, writing long after the age when most people retire, in the twilight of the print culture that has nourished my life. Yet it is sobering for me — as it is for Americans in many businesses and professions that once seemed a sure thing — to see younger near contemporaries being downsized out of jobs long before they are emotionally or financially ready for retirement.

Furthermore, I am acutely aware — and this is the difference between hope and expectation — that my plans depend, above all, on whether I am lucky enough to retain a working brain. I haven’t mentioned, because I don’t like to think about it, that my paternal grandmother, who also lived into her 90s, died of Alzheimer’s disease. The risk of dementia, of which Alzheimer’s is the leading cause, doubles every five years after 65.

Contrary to what the baby boom generation prefers to believe, there is almost no scientifically reliable evidence that “living right” — whether that means exercising, eating a nutritious diet or continuing to work hard — significantly delays or prevents Alzheimer’s. This was the undeniable and undefiable conclusion in April of a major scientific review sponsored by the National Institutes of Health.

Good health habits and strenuous intellectual effort are beneficial in themselves, but they will not protect us from a silent, genetically influenced disaster that might already be unfolding in our brains. I do not have the slightest interest in those new brain scans or spinal fluid tests that can identify early-stage Alzheimer’s. What is the point of knowing that you’re doomed if there is no effective treatment or cure? As for imminent medical miracles, the most realistic hope is that any breakthrough will benefit the children or grandchildren of my generation, not me.

I would rather share the fate of my maternal forebears — old old age with an intact mind in a ravaged body — than the fate of my other grandmother. But the cosmos is indifferent to my preferences, and it is chilling to think about becoming helpless in a society that affords only the most minimal support for those who can no longer care for themselves. So I must plan, as best I can, for the unthinkable.

I have no children — a much more common phenomenon among boomers than among old people today. The man who was the love of my adult life died several years ago; now I must find someone else I trust to make medical decisions for me if I cannot make them myself. This is a difficult emotional task, and it does not surprise me, for all of the public debate about end-of-life care in recent years, that only 30 percent of Americans have living wills. Even fewer have actually appointed a legal representative, known as a health care proxy, to make life-and-death decisions.

I can see that the “90 is the new 50” crowd might object to my thinking more about worst-case scenarios than best-case ones. But if the best-case scenario emerges and I become one of those exceptional “ageless” old people so lauded by the media, I won’t have a problem. I can also take it if fate hands me a passionate late-in-life love affair, a financial bonanza or the energy to write more books in the next 25 years than I have in the past 25.

What I expect, though — if I do live as long as the other women in my family — is nothing less than an unremitting struggle, ideally laced with moments of grace. On that day by the riverbank — the last time we saw each other — Gran cast a lingering glance over the water and said, “It’s good to know that the beauty of the world will go on without me.”

If I can say that, in full knowledge of my rapidly approaching extinction, I will consider my life a success — even though I will have failed, as everyone ultimately does, to defy old age.

Susan Jacoby is the author, most recently, of the forthcoming “Never Say Die: The Myth and Marketing of the New Old Age.”

A version of this op-ed appears in print on December 31, 2010, on page A23 of the New York edition with the headline: Real Life Among the Old Old. Today's Paper|Subscribe